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2018/2019 > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

What is a tumour?

A

A swelling that can be benign or malignant.

May even be inflammatory, or a foreign body.

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2
Q

What is a neoplasm?

A

A new growth that is not in response to a stimulus.

Can be benign, premalignant, or malignant.

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3
Q

Define “malignant”

A

A tumour with metastatic potential, that goes beyond the basement membrane.

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4
Q

Define “metaplasia”

A

Reversible change from one mature cell type to another mature cell type.

Represents a change in signals delivered to stem cells causing them to differentiate down a different line.

Signals may be cytokines, growth factors, etc.

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5
Q

Metaplastic tissue is….

A

….an at risk site for the development of cancer

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6
Q

Define “hyperplasia”

A

The enlargement of cells

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7
Q

What is dysplasia?

A

Disordered growth
Abnormal cells
No invasion
Often graded between most normal and closest to cancer

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8
Q

Factors that cause cancer

A 
Genes
Smoking
Alcohol
UV radiation
Other radiation
Drugs
Infections
Obesity
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9
Q

What are Weinberg’s Hallmarks?

A 
Increase growth signals
Remove growth suppression
Avoid apoptosis
Achieve immortality
Become invasive
Make your own blood supply (angiogenesis)
Less of DNA spell checks
Avoid the immune system
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10
Q

What is the double hit hypothesis?

A

One working gene is enough.
Two faulty copies have a functional problem.
Those who have inherited one faulty copy are at higher risk

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11
Q

What are initiators?

A

Causing long lasting genetic damage.
Not sufficient to cause cancer.
Most be followed by a promoter to require initiators to have caused damage.

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12
Q

What is a promoter?

A

Require initiators to have caused damage.

Time period can vary after initiation.

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13
Q

Chemical carcinogens is all seem to cause what?

A

DNA damage. Seem to cause specific and recurrent genetic alteration based on the chemical involved.

Aflatoxin = p53

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14
Q

Polycyclic aromatic hydrocarbons are…

A

A potent carcinogen.
Paint it on skin = cancer
Can be present in animal fat

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15
Q

Aflatoxins cause

A

Liver cancers.
They are from fungus and common in china.
Associated with p53 mutations.

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16
Q

What are the three categories of growth receptors?

A

Receptors with intrinsic tyrosine kinase activity

7 transmembrane G protein-coupled receptors

Receptors without intrinsic tyrosine kinase activity

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17
Q

MAPK/ERK Pathway

A

EGFR overexpression
RAS mutation
BRAF mutation

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18
Q

C-KIT mutation leads to…

A

Gastrointestinal stromab tumours

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19
Q

BRAF leads to what cancers?

A

Melanomas

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20
Q

Myc is

A

One of the last points in the sequence.
Myc is a nuclear transcription factor that promotes growth.
Common in lymphoma, neuroblastoma, small cell carcinoma of the lung.

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21
Q

PI3K

A

Most commonly mutated kinase in cancer

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22
Q

Tumour suppressor genes

A

Proteins that inhibit the cell cycles, often prefixed by a little “p”
For example p53

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23
Q

What does p53 do?

A

Senses DNA abnormalities at G1 and pauses the cells cycle. Increases levels of p21 which is a CDK inhibitor.
If DNA repaired, p53 restarts the cell cycle, if not it initiates apoptosis

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24
Q

PTEN

A

Increases transcription of p27
P27 blocks CDKs and cell cycle progression.
Inhibits PI3K/AKT pathway.
Without PTEN, p27 cells can proliferate in an uncontrollable fashion

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25
Q

In malignancy there is often a mutation that reactivates what?

A

Telomerase

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26
Q

What is Bcl-2?

A

BCl-2 is an anti apoptotic molecule that binds Bax/Bak to stop holes being punched in mitochondria
Follicular lymphoma switches on Bcl-2

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27
Q

Note on angiogenesis in cancer

A

Cancers grow fast so there is an increased demand for blood supply
Therefore a common feature of malignancy is necrosis
“Successful” cancers must create their own blood supply

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28
Q

What is PD-L1

A

Programmed death - ligand 1
Inhibits T-cell proliferation
Tumours can over express PD-L1 and avoid the immune system

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29
Q

Becoming metastatic

A

Needs to enter through vessel wall and survive in the vessel, get back through vessel wall and anchor in a new organ

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30
Q

Four things that the team wants to know from a pathologist

A

Is it out?
What is it?
How far has it gone?
How bad is it?

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30
Q

Lesions may be encapsulated because…

A

Most growing lesions stimulate a response by the surrounding tissue, often we try and fence it off with a capsule.

This takes time therefore encapsulated lesions are usually slow growing. These are usually benign.

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30
Q

What are the rough criteria for telling if a lesion is malignant?

A

Look nasty, don’t look natural
Irregular
Infiltrative
Destructive

31
Q

What are the rough criteria for telling if a lesion is benign?

A

Nature likes organisation

Symmetry

32
Q

Define “well differentiated”

A

Look more like what they should look like

33
Q

Define “poorly differentiated”

A

Difficult to tell what the cell of origin is

34
Q

Epithelial malignancy is…

A

Carcinomas

35
Q

Glandular lesions are…

A

Adenocarcinoma

Adenoma

36
Q

Squamous lesions are

A

Papilloma

SCC

37
Q

Bladder lesions are…

A

Transitional cell carcinoma

38
Q

Malignant lesions of the mesenchyme are known as…

A

Sarcomas

39
Q

Benign tumours of fat tissue are…

A

Common

Lipoma

40
Q

Malignant lesions of fat tissue are…

A

Rare

Liposarcoma

41
Q

Benign lesion of bone

A

Osteoma

42
Q

Malignant lesions of bone are…

A

Osteosarcoma
Rare
In children and long bones

43
Q

Benign lesions of cartilage are…

A

Enchondroma

44
Q

Malignant lesions of cartilage are….

A

Chondrosarcoma

45
Q

Skeletal muscle tumours

A

Rhabdomyoma - rare, children

Rhabdomyosarcoma - rare, eye, bile duct, gynae tract

46
Q

Benign lesion of the smooth muscle

A

Leiomyoma

One of the most common tumours in the body

47
Q

Malignant lesion of the smooth muscle

A

Leiomyosarcoma

very uncommon

48
Q

Benign lesions of the nerves

A

Neurofibromas

Schwannoma

49
Q

Malignant lesions of the nerves

A

Malignant peripheral nerve sheath tumour

50
Q

Benign lesions of the blood vessels

A

Haemangioma

51
Q

Malignant lesions of the blood vessels

A

Angiosarcoma

Kaposi’s sarcoma

52
Q

The CNS gets what lesions

A

Gliomas

53
Q

Cancers of the blood are all…

A

Malignant

54
Q

T part of TNM staging

A

T1 - tumour invades mucosa or submucosa
T2 - tumour invades muscularis proprialisiertes of size >2cm
T3 - tumour invades subserosa or fat
T4 - tumour directly invades other organs or structure

55
Q

N part of TNM staging

A

N0 - no regional lymph node metastasis

N1 - regional lymph node metastasis

56
Q

M part of TNM staging

A

M0 - no distant metastasis

M1- distant metastasis

57
Q

Well differentiated cancers are generally what grade?

A

Low grade

58
Q

Poorly differentiated cancers are generally what grade?

A

High grade

59
Q

Define pleomorphism

A

A term describing variability in size, shape and staining of cells.

60
Q

Define hyperchromasia

A

An increased staining capacity of cells

61
Q

What tumours present early?

A

Vocal cord - change in voice occurs early
Skin cancers - can see them
Breast cancer - self-examination
Testicular cancer - self-examination

62
Q

Effects of cancer on the lung

A

Decreased area of healthy lung
Decreased oxygen consumption
infection secondary to obstruction
Often late occurrence and large, multiple tumours.

63
Q

Effects of cancer on the bladder and kidney

A

Obstruction - can’t drain urine
Backwards pressure
Kidney stops functioning
Build up of toxins and abnormal electrolyte balance

64
Q

Effects of cancer of the brain

A

No such thing as benign
Pressure increases
Seizures - don’t breath

65
Q

Patients with cancer may feel very lethargic because…

A

Tumours are very metabolically active and require energy

66
Q

In cancer weight loss is known as…

A

Cachexia

67
Q

Cachexia is caused by…

A

Energy use of the tumour

Molecules produced by the tumour that result in increased metabolism such as tissue necrosis factor

68
Q

Define infiltration

A

Direct invasion of other structures

69
Q

Infiltration of nerves causes

A

Loss of motor functions (swallowing, etc.) or sensory functions (loss of sensation)

70
Q

Infiltration of blood vessels can cause…

A

Haemorrhage

Often the cause of sudden death in patients with known cancer

71
Q

Paraneoplastic syndromes are caused by

A

Not directly related to the tumour but the tumour can produce hormones that result in electrolyte disturbances, osteoarthropathy, unsusual neurological symptoms

72
Q

How can tumours cause immunosuppresion

A

Tumours express proteins that are not normally expressed. These can stimulate and immune response.

Often tumours that stimulate a strong immune response have a good prognosis.

Infection is not an uncommon cause of death in cancer patients

73
Q

Problems caused by metastases

A

Liver - loss of function
Lungs - loss of function
Bone - pathological fracture, high levels of calcium (arrhythmia), kidney problems

74
Q

Lung cancers metastasise to where?

A

Bone
Brain
Adrenal
Liver

75
Q

Breast cancers will metastasise to where?

A

Bone
Brain
Adrenal
Liver

76
Q

GI cancers metastasise to where?

A

Liver

Rarely other sites

77
Q

Where will prostate cancer metastasise to?

A

Will pop up anywhere

2018/2019 (9 decks)

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